1740463504 NPI number — PREFERRED CARE CHIROPRACTIC, P.A., INC.

Table of content: (NPI 1740463504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740463504 NPI number — PREFERRED CARE CHIROPRACTIC, P.A., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED CARE CHIROPRACTIC, P.A., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740463504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12715 WARWICK BLVD
Provider Second Line Business Mailing Address:
SUITE I
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-890-2030
Provider Business Mailing Address Fax Number:
757-265-1282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12715 WARWICK BLVD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23606-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-890-2030
Provider Business Practice Location Address Fax Number:
757-265-1282
Provider Enumeration Date:
12/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FREEDMAN
Authorized Official First Name:
STUART
Authorized Official Middle Name:
IRWIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-890-2030

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0104001912 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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